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HomeMy WebLinkAboutInspection and Testing Form - Inspection - 11/14/2014 INSPECTION AND TESTING FORM Date: 11/12/14 Time: 1:37 PM SERVICE ORGANIZATION PROPERTY NAME (USER) Name: Lowell Central Electric Naive: North Andover Mall Address: 182 Chelmsford St,Lowell, MA 01854 Address: 350 Winthrop Ave Representative: Arthur Methot Owner Contact: License No.: A12566 Telephone: Telephone: (978)453-7826 APPROVING AGENCY MONITORING ENTITY Contact: Contact: Telepbone: Telephone: SERVICE Monitoring Account Ref.No.: ❑Weekly ❑Monthly ❑Quarterly TYPE TRANSMISSION ❑Semiannually ❑Annually ❑McCullob ❑Multiplex ❑Digital ®Other(Specify) New Install ❑Reverse Priority ❑RF ❑Other(Specify) Control Unit Manufacturer: Mircom Model No.: Circuit Styles: FA-300 Number of Circuits: 8 Software Rev.: V.1.7.8 Last Date System Had Any Set-vice Performed: Last Date That Any Software or Configuration Was Revised: 11/12/14 ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Quantity of Devices Installed Circuit Style Devices Tested 2 A 2 Manual Fire Alarm Boxes ton Detectors Photo Detectors 1 A 1 Duct Detectors Heat Detectors WaterElow Switches Supervisory Switches Other(Specify): Alarm verification feature is ®disabled ❑enabled NFPA 72, Figure 10.6.2.3(p. 1 of 6) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribOon. ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity of Quantity of Appliances Installed Circuit Style Appliances Tested Bells 3 A 3 Horns Chimes 6 A 6 Strobes Speakers Other(Specify): No.of alarm notification appliance circuits: 4 Are circuits monitored for integrity? ®Yes ❑No SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Quantity of Devices Installed Circuit Style Devices Tested Building Temp. Site Water Temp. Site Water Level Fire Pump Power Fire Pump Running Fire Pump Auto Position Fire Pump or Pump Controller Trouble ...... Fire Pmnp Running Generator in Auto Position Generator or Controller Trouble Switch Transfer Generator Engine Running Other(Specify): SIGNALING LINE CIRCUITS Quantity and style of signaling line circuits connected to system(see NFPA 72®, Table 6.6.1): Quantity Style(s) SYSTEM POWER SUPPLIES (a)Primary(Main): Nominal Voltage 120VAC Amps 3 Overcurrent Protection: Type Circuit breaker Amps 20 Location(of Priniary Supply Panelboard): Stock room Disconnecting Means Location: Panelboard LP#4 CRT-34 NFPA 72, FigUre I0.6.2.3(1). 2 of(3) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.it may not be copied for commercial sale or distribution. (b)Secondary(Standby): 24VDC Storage Battery:Arnp-Hr Rating 12 Calculated capacity in Standby Mode Amp-Hrs to operate system for 24 hours Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ❑Dry Cell ❑ Lead-Acid ❑Nickel-Cadmium ❑Other(Specify): ® Sealed Lead Acid (c)Emergency or standby system used as a backup to primary power supply,instead of using a secondary power supply: Emergency system described in NFPA 70,Article 700 Legally required standby described in NFPA 701,Article 701 Optional standby system described in NFPA 70,Article 702,which also meets the performance requirements of Article 700 or 701 PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Yes No Who Time Monitoring Entity ❑ ❑ Building Occupants ❑ ❑ Building Management ❑ ❑ Other(Specify) ❑ ❑ AHJ Notified of Any Impairments ❑ ❑ SYSTEM TESTS AND INSPECTIONS TYPE Visual Functional Comments Control Unit Interface Equipment Lamps/LEDs Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring NFPA 72, FiUore 10.6.2.3(p. 3 of G) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may noL be copied for commercial sale or distribution. SECONDARY POWER TYPE Visual Functional Comments Battery Condition Load Voltage Discharge Test Charger Test Specific Gravity TRANSIENT SUPPRESSORS ❑ REMOTE ANNUNCIATORS ❑ ❑ NOTIFICATION APPLIANCES Audible Visible Speakers ❑ ❑ Voice Clarity [) INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS Device Visual Functional Measured Loc.&SIN Type Check Test Factory Setting Setting Pass Fail ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Comments: EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments Phone Set ❑ ❑ Phone Jacks ❑ ❑ Off-Book Indicator ❑ ❑ Aniplifier(s) ❑ ❑ Tone Generator(s) ❑ ❑ Call-in Signal ❑ ❑ System Perfonnance ❑ El NFPA 72, Figure 10.6.2.3(p. 4 of 6) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.it may not be copied for commercial sale or distribution. Visual Device Operation Simulated Operation COMBINATION SYSTEMS Fire Extinguisher Monitoring Device/System ❑ ❑ ❑ Carbon Monoxide Detector/System ❑ ❑ ❑ (Specify) ❑ [] ❑ INTERFACE EQUIPMENT (Specify) ❑ ❑ ❑ (Specify) ❑ ❑ ❑ (Specify) ❑ ❑ ❑ SPECIAL HAZARD SYSTEMS (Specify) ❑ ❑ ❑ (Specify) ❑ ❑ ❑ (Specify) ❑ ❑ ❑ Special Procedures: Comments: SUPERVISING STATION MONITORING Yes No Time Comments Alarm Signal ❑ ❑ Alarm Restoration ❑ ❑ Trouble Signal ❑ ❑ Trouble Signal Restoration ❑ ❑ Supervisory Signal ❑ ❑ Supervisory Restoration ❑ ❑ NOTIFICATIONS THAT TESTING IS Yes No Who Time COMPLETE Building Management ❑ ❑ Monitoring Agency ❑ ❑ Building Occupants ❑ ❑ Other(Specify) ❑ ❑ The following did not operate correctly: System restored to normal operation: Date: 11/12/14 Time: 253 PM NFPA 72, Figure 10.6.2.3(p. 5 of 6) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.11 may not be copied for commercial sale or distribution. THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS Name of Inspector: Arthur Methot Date: 11/12/14 Time: 1:37 PM Signature: Name of Owner or Representative: Date: Time: Signature: NFPA 12, Figure 10.6.2.3{p. 6 of 6) Copyright©2009 National Fire Protection Association.This form maybe copied for individual use other than for resale.It may not be copied for commercial safe or distribution.